Introduction

The introduction of total mesorectal excision (TME) for rectal cancer was popularised and promoted by Heald from 1979 onwards. He described dissection in the “holy plane” maintaining the integrity of the mesorectal fascial envelope. Since then, there has been a dramatic fall in the rate of local recurrence and an increase in 5-year survival following surgery for rectal cancer [1, 2].

Laparoscopic ultra-low anterior resection (LULAR) for rectal cancer currently remains controversial. Although long term follow-up results are pending, several major trials have failed to show short-term non-inferiority when compared to open resection [3, 4]. LULAR is, however, widely practiced and this is likely to continue into the future, especially due to the ongoing drive towards minimally invasive surgery and the recent ROLARR trial failing to confer a significant benefit of robotic TME over laparoscopic TME [5].